Fostering resilience and well-being in emerging adults with adverse childhood experiences: study protocol for a randomized controlled trial to evaluate the FACE self-help app

BACKGROUND

Adverse childhood experiences (ACE) are linked to an increased risk of psychological disorders and lower psychosocial functioning throughout life. This study aims to evaluate the FACE self-help app, designed to promote resilience and well-being in emerging adults with a history of ACE. The app is based on cognitive-behavioural principles and consists of two thematic components: (1) self- and emotion regulation (SER) and (2) social skills and biases in social information processing (SSIP).

METHODS

The efficacy of the app will be tested through a single-centre, two-arm randomized controlled trial, comparing an active intervention group against a waiting list control group. The active group is divided into two subgroups, in which the two components are delivered in a different order to investigate differential effects in a crossover design. Up to 250 emerging adults aged 18 to 25 years with a history of ACE from a general population cohort study will be recruited. The primary objective is to test the efficacy of the app in improving resilience (primary outcome) and well-being (co-primary outcome) compared to a waiting list control group and to examine the stability of these effects. The secondary objectives include testing the efficacy of the app in improving the secondary outcomes, i.e., self-efficacy in managing emotions, problem solving, fear of evaluation, social avoidance, and self-esteem; examining the differential effects of the two components; and assessing the effect of the app on real-life data on resilience, affective states, distress in social interactions and coping strategies. Furthermore, the study will investigate potential moderators (e.g. ACE severity) and mediators of intervention outcomes (e.g. self-efficacy in managing emotions).

DISCUSSION

The results will provide insights into the efficacy of the self-help intervention as well as mediators and moderators of outcomes. Furthermore, results will extend the existing knowledge by testing the differential effects of the SER and SSIP component on the outcomes. Findings can inform improvements to the FACE app and the development of other interventions for this target group and assess its potential as a scalable, low-threshold intervention to support emerging adults with a history of ACE in their transition to adulthood.

TRIAL REGISTRATION NUMBER

NCT05824182.

Was retrospective change measurement conducted with Covid-19 containment inconsistent? Comparing prospective and retrospective change measures using data from a national survey on substance use and addictive behaviors

Single-measurement-point data collection to assess change has increased with studies assessing the impact of the Covid-19 pandemic and of its containment, despite evidence of its lack of validity. Retrospective change is not equivalent to change in repeated self-reported measures giving raise to questions about the validity of the former. This paper purports to investigate inconsistencies between change measures by confronting retrospective change to information from longitudinally self-reported measures from the C-SURF cohort study. The study sample consists of 2,279 young men who participated in C-SURF between 2020 and 2021, and completed between May and June 2021 a survey covering change in alcohol, cigarette, cannabis and other addictive behaviors related to the pandemic. The aforementioned behaviors were assessed longitudinally at two time points using self-reports, and retrospective change since the onset of the Covid-19 crisis was also assessed at the second measurement time. Information from both prospective and retrospective change measures were confronted to identify inconsistent information for each behavior. Additionally, multiple logistic regressions were performed to assess associations between socioeconomic status, impulsivity, depression, and different indicators of motivation to complete the study and inconsistency between both measures for each behavior of interest. Importantly, inconsistent information in at least one of the investigated behaviors was found in about 90% of the participants. Small associations were found between inconsistency and different factors with a consistent effect of impulsivity. In the absence of evidence of the validity of retrospective change measures, studies relying on retrospective change should be interpreted with caution.

Associations of binge gaming (5 or more consecutive hours played) with gaming disorder and mental health in young men

BACKGROUND

Video gaming is a popular activity among young people. Time spent with gaming was found to be only moderately associated with gaming disorder. However, patterns of binge gaming (playing more than 5 h consecutively) were rarely considered in research on gaming. This study explores how binge gaming frequency is related with gaming disorder and mental health.

METHODS

The sample came from the Cohort study on substance use risk factors (C-SURF) and comprised 5,358 young men aged 28.26 years (SD = 1.27). ANCOVA was conducted to estimate the association between binge gaming frequency (gaming at least 5 h consecutively) and gaming disorder (measured with the Game Addiction Scale) as well as indicators of mental health.

RESULTS

A total of 33.3% of the sample engaged in binge gaming at least once in the previous year, and 6.1% at least weekly. Frequency of binge gaming was associated with gaming disorder score in a linear dose-response relationship (linear trend = 2.30 [2.14, 2.46]) even if adjusted for time spent gaming (linear trend = 1.24 [1.03, 1.45). More frequent binge gaming was associated with lower life satisfaction and sleep quality, and with more major depression and social anxiety disorder symptoms.

CONCLUSIONS

Binge gaming patterns, especially daily or almost daily binge gaming, are important to consider with regard to gaming disorder and mental health. Asking about binge gaming may be a promising screening question for gaming related problems. Encouraging regular breaks from gaming may be a valuable prevention strategy to reduce negative outcomes of gaming.

Longitudinal Associations between Sensation Seeking and Its Components and Alcohol Use in Young SWISS Men-Are There Bidirectional Associations?

The association between alcohol use and sensation seeking is well known. Less is known about whether longitudinal changes in alcohol use are associated with changes in sensation seeking and in which direction influence might flow. 5125 men aged 20.0 years old at baseline and 25.4 years old at follow-up responded to the Brief Sensation Seeking Questionnaire, which measures four subscales of experience seeking, boredom susceptibility, thrill- and adventure-seeking, and disinhibition. Alcohol use was measured using volume (drinks per week) and binge drinking (about 60 g or more per occasion). Associations were calculated using cross-lagged panel models and two-wave latent change score models. Correlations between the latent change scores for alcohol use and the sensation-seeking subscales were all positive, being largest for disinhibition (r > 0.3) and much smaller (r ~ 0.1) for the others. Disinhibition was the dominant effect over the entire sensation-seeking scale. Cross-lagged paths were (except for thrill- and adventure-seeking) bidirectional and mostly higher from alcohol use to sensation seeking (e.g., path_{volume-disinhibition} = 0.136, and path_{disinhibition-volume} = 0.072). Again, effects were highest for disinhibition. Given the bidirectional links between sensation seeking and alcohol use, preventive efforts aiming to achieve stable positive changes in alcohol use and personality should target both simultaneously and focus on disinhibition.

Longitudinal Development of Reasons for Living and Dying With Suicide Attempters: A 2-Year Follow-Up Study

BACKGROUND

Clinical interventions for patients after a suicide attempt might include a focus on Reasons for Living (RFL) and/or Reasons for Dying (RFD). The present study examined the longitudinal development of RFL and RFD in patients with and without a suicide-specific intervention - the Attempted Suicide Short Intervention Program (ASSIP).

METHODS

In this secondary analysis of a 2-year follow-up randomized controlled study, participants completed the Suicide Status Form II to assess RFL and RFD, at baseline, as well as at 6-, 12-, 18-, and 24-months follow-up. Growth models and latent class analysis were used to investigate longitudinal developments in RFL and RFD. Regression models were used to test the association between RFL, RFD and suicidal reattempts and ideation.

RESULTS

Cross-sectionally and longitudinally, RFD, but not RFL, were associated with suicide reattempts and suicidal ideation. The number of RFD decreased significantly across the 24 month period (from 1.90 at t1 to 1.04 at t5 in the control group and from 2.32 at t1 to 0.51 at t5 in the intervention group), and this decrease was stronger (b = -0.02; p = 0.004) in the ASSIP group than in the control group. There was no overall change in RFL. Three latent trajectories of RFD were identified: a decreasing (n = 77), a steady high (n = 17) and a trajectory with first increasing and then decreasing RFD (n = 26). The proportion of patients in the ASSIP intervention was highest in the decreasing trajectory and lowest in the steady high trajectory. Patients in the steady high trajectory were characterized by worse mental health and fewer social obligations (partner, children) at baseline.

CONCLUSION

The results confirm the importance of RFD within the suicidal process and show that the number of RFD can be further reduced over the period of 24 months with short interventions such as ASSIP. The relevance of number of RFL in the suicidal process, as protective factor, was not confirmed. In the subgroup of patients whose RFD did not decrease over a long period of time, there is a particularly high risk of suicidal ideation/behavior. Clinical interventions should focus more closely on RFD, their etiology and maintenance.

Prevalence, modes of administration and motives for cannabidiol use in young Swiss men

AIMS OF THE STUDY

In Switzerland, there has been a boom in the market for cannabidiol (CBD) products in recent years. However, little is known on the prevalence, modes of administration and motives for use of CBD products. The aim of the present study was to fill this gap using recent (2019) data from the Cohort Study on Substance Use Risk Factors (C-SURF).

METHODS

Between April and December 2019, an unselected sample of 5233 Swiss young men from the French- and German-speaking regions (mean age 28.2 years, standard deviation 1.3) completed a self-report questionnaire covering measures of use of CBD products, modes of administration and motives to use of CBD, tetrahydrocannabinol (THC) and cigarettes. Descriptive statistics were used to estimate prevalence of self-reported use, modes of administration and motives to use CBD, whereas logistic regression models were used to test the associations of linguistic region, THC and tobacco use with use of CBD.

RESULTS

Lifetime and 12-month prevalence of self-reported use of CBD were 32.4% and 18.5%, respectively. Among past 12-month CBD users, 79.4% used CBD once a month or less often, whereas 20.6% used it more than once a month. The most often reported modes of administration of CBD were in association with tobacco: flowers mixed with tobacco (67.5%), and CBD cigarettes with tobacco (37.1%), while 18.6% used flowers without tobacco. The three most reported reasons for using CBD were: out of curiosity (74.0%), to feel the effects of THC (38.1%) and for well-being and health (37.5%). In multivariable models, CBD use was associated with use of THC (odds ratio [OR] 9.85, 95% confidence interval [CI] 8.28-11.73), cigarettes (OR 2.74, 95% CI 2.28-3.29) or e-cigarettes (OR 1.5795% CI 1.27-1.95), as well as for the linguistic region (French-speaking vs German-speaking region OR 1.3895% CI 1.15-1.65).

CONCLUSIONS

Self-reported use of CBD is common among young Swiss men: about one third used CBD in their life and about one in five in the previous 12 months. However, the vast majority of CBD users used it infrequently and out of curiosity. CBD use was particularly prevalent among users of THC and cigarette smokers. CBD was most often used in combination with tobacco, thus exposing users to risks associated with smoking tobacco products.

Sexual Minority Orientation Is Associated With Greater Psychological Impact Due to the COVID-19 Crisis-Evidence From a Longitudinal Cohort Study of Young Swiss Men

Background: The COVID-19 pandemic and its countermeasures may have had a significant impact on the psychological well-being of specific population subgroups. The present study investigated whether sexual minority men (defined here as attracted partly or exclusively to men) from an ongoing cohort study of young Swiss men experienced different psychological impacts, levels of substance use and addictive behaviors, and to which degree pre-existing vulnerabilities and participants experiences during the crisis might explain these differences.

Methods: An ongoing cohort sample based on the general population of young Swiss men (mean age = 29.07 years; SD = 1.27) was assessed before and during the COVID-19 crisis for depression, stress, sleep quality, substance use and addictive behaviors. Additionally, during the crisis, we assessed its impact in form of fear, isolation and traumatic experiences. Potential associations between these outcomes and sexual orientation (sexual minority vs. heterosexual) were tested using linear regression models. It was additionally estimated to which degree these associations were attenuated if adjusted for differences in mental health, personality and socioeconomic status before the crisis, as well as the experience of the COVID-19 crisis (infection with the virus and changes to work situation).

Results: Compared to heterosexual men, sexual minority men showed higher levels of psychological trauma (b = 0.37 [0.25, 0.49]), fear (b = 0.18 [0.06, 0.30]) and isolation (b = 0.32 [0.20, 0.44]) due to the COVID-19 pandemic as well as higher levels of depression (b = 0.31 [0.20, 0.41]) and lower sleep quality (b = −0.13 [−0.24, −0.02]) during the crisis. These differences were to a large degree explained by higher pre-crisis levels of mental health problems and the personality dimension of neuroticism-anxiety. Sexual minority men showed higher overall levels of substance use and addictive behaviors, but these differences were already present before the crisis.

Conclusion: The COVID-19 crisis may have worsened pre-existing vulnerabilities in sexual minority men, leading to its greater psychological impact on them than on heterosexual men. Reducing minority stress due to sexual orientation may help not only to improve mental health among important proportions of the population but also to reduce their vulnerability to crises. Services offering psychological support to sexual minorities may need to be reinforced during crises.

Changes in substance use and other reinforcing behaviours during the COVID-19 crisis in a general population cohort study of young Swiss men

BACKGROUND AND AIMS

There are concerns about the potential impact of the coronavirus disease (COVID-19) pandemic on substance use (SU) and other reinforcing behaviours (ORB). This paper investigates changes in SU and ORB among young men during the COVID-19 crisis (i.e. March-June 2020).

METHODS

Before and during the COVID-19 crisis, 2,344 young Swiss men completed questionnaires covering SU (i.e. alcohol, cigarettes, illegal cannabis), ORB (i.e. gaming, watching TV series, internet pornography) and sociodemographic and work-related characteristics (i.e. deterioration in the work situation, change in working hours, change in working hours from home, healthcare workers' and other professionals' contacts with potentially infected people, linguistic region, call up to military or civil protection unit, living situation, age).

RESULTS

Latent-change score models showed significant decreases of 17% for drinking volume and frequency of heavy episodic drinking, and a significant increase of 75% for time spent gaming and watching TV series. Subgroups showed greater relative increases. French-speaking participants, those who experienced a deterioration in their work situation and healthcare workers in contact with potentially infected people reported increased cigarette use. Those without children increased gaming, whereas those who worked fewer hours, experienced a deterioration in their work situation or were French-speaking did more gaming and watched more TV series. Those who lived alone or were German-speaking watched more internet pornography.

CONCLUSION

During the COVID-19 crisis, young Swiss men drank less alcohol and spent more time gaming and watching TV series. Changes in SU and ORB were not homogenous in the young Swiss men population.

The psychological impact of the COVID-19 crisis on young Swiss men participating in a cohort study

AIMS

The COVID-19 pandemic caused many disturbances to daily life worldwide and may also have significantly affected people's psychological well-being. The present study aimed to describe the psychological impact of the crisis on our sample of young Swiss men and to examine differences due to their linguistic region, experiencing COVID-19 symptoms and living arrangements.

METHODS

Based on an ongoing cohort study, we assessed a general-population sample of young Swiss men (n = 2345; average 29 years old) shortly before (from April 2019) and early on during the COVID-19 crisis (between 13 May and 8 June 2020). This was a unique opportunity to estimate the crisis' psychological impact in the form of depression, perceived stress and sleep quality (assessed before and during COVID-19), and any crisis-induced fears, isolation or psychological trauma. Associations of psychological impact with living arrangements, experiencing COVID-19 symptoms and linguistic region (German-speaking vs French-speaking) were investigated using linear regression models.

FINDINGS

By the time participants responded to our questionnaire, less than 1% had been tested positive for COVID-19, 2.6% had been tested negative and 14.7% had had some COVID-19 symptoms but had not been tested. About 8.2% of the sample reported at least some symptoms of psychological trauma (≥24 points on the Impact of Event Scale). On average, participants reported higher levels of fear for others (43.6% at least moderate) and economic fear (12.7% at least moderate) than fear for themselves (5.8% at least moderate). Those living alone and those who reported having COVID-19 symptoms themselves, or knowing someone with symptoms, reported higher overall psychological impact in the form of depression, perceived stress, sleep quality, psychological trauma, fear and isolation. Associations with linguistic region varied by outcome, with higher levels of depression and fear in French-speaking regions and higher levels of perceived stress and isolation in German-speaking regions.

INTERPRETATION

The crisis had a considerable impact on the psychological well-being of our sample of young Swiss men, and some groups were more affected than others: those living alone and those who had shown COVID-19 symptoms themselves or had known someone with symptoms may have felt a greater psychological impact from the crisis. Supporting those at a higher risk of psychological consequences in such crises, whether through structural measures or via individual support, should be an important aspect of crisis management and could help reduce the overall impact of the current pandemic on Switzerland's population.

The psychological impact of the COVID-19 crisis is higher among young Swiss men with a lower socioeconomic status: Evidence from a cohort study

AIMS

The present study aimed to investigate whether the psychological impact of the COVID-19 crisis varied with regards to young Swiss men's pre-crisis level of education and socioeconomic status and to changes in their work situation due to it.

METHODS

A cohort of 2345 young Swiss men (from 21 out of 26 Swiss cantons; mean age = 29) completed survey-based assessments shortly before (April 2019 to February 2020) and early on during the COVID-19 crisis (May to June 2020). Outcomes measured were psychological outcomes before and during the COVID-19 crisis (depression, perceived stress and sleep quality), and the fear, isolation and psychological trauma induced by it. We investigated associations between these outcomes and their predictors: pre-crisis socioeconomic status (relative financial status, difficulty paying bills, level of education), changes in work situation during the crisis (job loss, partial unemployment, working from home, change in workload) and working in contact with potentially infected people, both inside and outside the healthcare sector. For outcomes measured before and during the crisis, the analyses were adjusted for their pre-crisis levels.

RESULTS

About 21% of participants changed their employment status (job loss, partial unemployment or lost money if self-employed) and more than 40% worked predominantly from home during the COVID-19 crisis. Participants with a lower relative socioeconomic status already before the crisis experienced a higher psychological impact due to the COVID-19 crisis, compared to participants with an average socioeconomic status (major depression (b = 0.12 [0.03, 0.22]), perceived stress (b = 0.15 [0.05, 0.25]), psychological trauma (b = 0.15 [0.04, 0.26]), fear (b = 0.20 [0.10, 0.30]) and isolation (b = 0.19 [0.08, 0.29])). A higher impact was also felt by participants who lost their job due to the COVID-19 crisis, the partially unemployed, those with an increased workload or those who worked mainly from home (e.g. depression b = 0.25 [0.16, 0.34] for those working 90%+ at home, compared to those not working at home).

CONCLUSIONS

Even in a country like Switzerland, with relatively high social security benefits and universal healthcare, the COVID-19 crisis had a considerable psychological impact, especially among those with a lower socioeconomic status and those who experienced deteriorations in their work situation due to the COVID-19 crisis. Supporting these populations during the crisis may help to prevent an amplification of inequalities in mental health and social status. Such support could help to lower the overall impact of the crisis on the mental well-being of Switzerland's population.

Behavioural addictions as risk factors for incidence and reoccurrence of suicide ideation and attempts in a prospective cohort study among young swiss men

Introduction

Substance use disorder, depression and sexual minority are well documented risk factors for suicidal behaviour, far less is known about behavioural addictions.

Objectives

First, to explore associations between behavioural addictions (gaming, gambling, cybersex, internet, smartphone, work) at age 25 and the incidence and reoccurrence of suicide ideation (SID), suicide attempts (SAT), and suicide attempts among those with suicide ideation (SATID) at age 28. Second, to test whether these associations were impacted by adjusting for cannabis and alcohol use disorder, nicotine dependence, sexual orientation and depression.

Methods

Based on two waves of a prospective cohort study of 5,428 young Swiss men, nested models with and without adjustment for risk factors were used to regress SID, SAT and SATID on preceding behavioural addictions.

Results

Without adjustment, each of the behavioural addictions at age 25 significantly predicted the incidence of SID and SAT at age 28. Gambling and cybersex addiction furthermore predicted SATID. When adjusting for other risk factors, associations with behavioural addictions were reduced, whereas depression and cannabis use disorder were the most important and consistent predictors for the incidence and recurrence of SID, SAT and SATID.

Conclusions

Among young Swiss men, behavioural addictions are important predictors of SID and SAT, however a large part of their association is shared with depression and cannabis use disorder. Treatment for addictive behaviors, especially cannabis use can open the door to larger mental health screening and targeted intervention. Crisis intervention among men presenting addictive behaviours with or without substance may therefore be key to preventing suicidal behaviour.

Disclosure

No significant relationships.

Psychological impact of the COVID-19 crisis on young swiss men participating in a cohort study: Differences due to socioeconomic status and work situation

Introduction

The COVID-19 pandemic impacted daily life worldwide. It may also have had a psychological impact, especially on those with less resources already before the crisis and those who reported substantial changes to their work situation.

Objectives

To investigate whether socioeconomic status before the crisis and changes in work situation during the crisis (unemployment, home-office) are associated with psychological impact in a cohort of young Swiss men.

Methods

A total of 2345 young Swiss men (mean age = 29) completed assessments shortly before (April 2019 to February 2020) and early during the COVID-19 crisis (May to June 2020). Assessments covered psychological outcomes assessed before and during COVID-19 crisis (depression, perceived stress and sleep quality), and assessed during the crisis (fear, isolation and COVID-19 psychological trauma), socioeconomic status (relative financial status and difficulty to pay bills) before the crisis and changes in work situation (unemployment, home-office).

Results

About a fifth of the sample were in partial unemployment or lost their job during COVID-19 crisis. Those in partial or full unemployment, those mostly working from home and those with a lower socioeconomic status already prior to the crisis showed overall higher levels of depression, stress, psychological trauma, fear and isolation.

Conclusions

Even in a country with high social security such as Switzerland, the COVID-19 crisis had a higher psychological impact on those who were already disadvantaged before the crisis or experienced deteriorations in their work situation. Supporting disadvantaged subpopulations during the crisis may help to prevent an amplification of pre-existing inequalities.

Disclosure

No significant relationships.

Cannabis use disorder trajectories and their prospective predictors in a large population-based sample of young Swiss men

BACKGROUND AND AIMS

Cannabis use disorder (CUD) is frequent in adolescence and often goes into remission towards adulthood. This study aimed to estimate trajectories of CUD severity (CUDS) in Swiss men aged from 20 to 25 years and to identify prospective predictors of these trajectories.

DESIGN

Latent class growth analysis of self-reported CUDS in a cohort study with three data collection waves.

SETTING

A general population sample of young Swiss men.

PARTICIPANTS

A total of 5987 Swiss men assessed longitudinally at the mean ages of 20, 21.5 and 25 years.

MEASUREMENTS

Latent CUDS in the last 12 months was measured at each wave with the Cannabis Use Disorders Identification Test-Revised (CUDIT-R). Predictors of CUDS trajectories, measured at age 20, were from six domains: factors related to cannabis use, family, peers, other substance use, mental health and personality.

FINDINGS

We distinguished four CUDS trajectories: stable-low (88.2%), decreasing (5.2%), stable-high (2.6%) and increasing (4.0%). Predictors were generally associated with higher odds of membership in the decreasing and stable-high trajectory (versus the stable-low), and to a lesser degree with higher odds of membership in the increasing trajectory. Bivariate predictors of persistent high CUDS (stable-high versus decreasing trajectory) were major depression severity [odds ratio (OR) = 1.19, 95% confidence interval (CI) = 1.01, 1.40], attention deficit hyperactivity disorder severity (OR = 1.25, 95% CI = 1.04, 1.51), antisocial personality disorder severity (OR = 1.18, 95 % CI = 1.04, 1.34), relationship with parents (OR = 0.74, 95% CI = 0.63, 0.88), number of friends with drug problems (OR = 1.33, 95% CI = 1.11, 1.60) and the personality dimensions neuroticism-anxiety (OR = 1.35, 95% CI = 1.11, 1.65) and sociability (OR = 0.78, 95% CI = 0.62, 0.97).

CONCLUSIONS

Factors associated with persistent cannabis use disorder in young Swiss men include cannabis use, cannabis use disorder severity, mental health problem severity, relationship with parents (before the age of 18), peers with drug problems and the personality dimensions neuroticism-anxiety and sociability at or before age 20. Effect sizes may be small, and predictors are mainly associated with persistence via higher severity at age 20 years.

Curvilinear associations between sexual orientation and problematic substance use, behavioural addictions and mental health among young Swiss men

BACKGROUND AND AIMS

It is well documented that individuals with a minority sexual orientation face greater risks of problematic substance use (e.g. heavy episodic drinking, alcohol use disorder) and mental health problems. Far less is known about how that risk varies within this population and their risk of behavioural addictions. This study estimated the risks of problematic substance use, behavioural addiction and poor mental health across the spectrum of sexual orientation.

SAMPLE AND METHOD

A sample of young Swiss men (N = 5294; mean age = 25.5, SD = 1.25; representative of 21 of Switzerland's 26 cantons) completed a self-reporting questionnaire on sexual orientation (attraction, 5-point scale) and criterion variables: problematic substance use (e.g. alcohol, cigarettes, cannabis and other illegal drugs), behavioural addictions (gambling, gaming, cybersex, internet, smartphone, work, exercise) and indicators of mental health (e.g. depression, stress). Curvilinear associations between sexual orientation (heterosexual, mostly-heterosexual, bisexual, mostly-homosexual or homosexual individuals) and criterion variables were explored using fractional polynomial regressions.

RESULTS

Although there were differences across criterion variables, in general, the highest risks of problematic substance use, behavioural addictions and mental health problems were estimated for mostly-heterosexual, bisexual or mostly-homosexual men, followed by homosexual men, and with heterosexual men facing the lowest risk.

DISCUSSION AND CONCLUSION

Aggregating the spectrum of sexual orientations into two or three distinct groups blurs important internal group differences. Outcome-specific explanations beyond minority stress and biphobia are necessary to understand the pathways between sexual orientation and risky behaviours. Considering sexual orientation is important to provide targeted healthcare prevention and interventions.

Protective behavioral strategies and alcohol outcomes: Impact of mood and personality disorders

Although young men or young adults with mental health disorders are at higher risk to engage in problematic drinking, they typically evince stronger associations between protective behavioral strategies (PBS) and fewer alcohol outcomes. This study aimed to contribute to this line of research by examining the moderating effect of depression, bipolar spectrum disorder, borderline personality disorder and social anxiety disorder on the association between PBS and alcohol outcomes. Participants (N = 4,960; mean age = 25.43) were young men participating in the Cohort Study on Substance Use Risk Factors. Measures of PBS use, typical drinks per week, alcohol-related consequences, depression, bipolar spectrum disorder, borderline personality disorder and social anxiety disorder were used from the second follow-up assessment. Main results indicated that the negative association between PBS and alcohol use was stronger in participants with borderline personality disorder than among those without this disorder. Unexpectedly, in participants with depression, PBS were not significantly associated with alcohol use, whereas they were related to fewer drinks among those without the disorder. Similarly, in participants with bipolar spectrum disorder, the association between PBS and alcohol-related consequences was not significant, whereas PBS were associated with fewer consequences in those without the disorder. Finally, findings indicated that social anxiety disorder did not significantly moderate the associations between PBS and alcohol outcomes. If replicated by future research, these findings imply that PBS-intervention may not equally impact young adults with diverse mental health disorders.

Online Gambling's Associations With Gambling Disorder and Related Problems in a Representative Sample of Young Swiss Men

Background and Aims: Internet gambling has recently grown in popularity, but relatively little is known about how online and the combination of online and offline (mixed) gambling are associated with gambling disorder (GD) and related problems. The present research examined in a cohort study sample of young Swiss men how their gambling activities and gambling-related problems differed across the spectrum from offline to online gambling. Sample: A general-population based sample from the Cohort Study on Substance Use Risk Factors (C-SURF), consisting of 5,352 young Swiss men (mean age 28.26 years old). Measures: The spectrum from exclusively offline to almost exclusively online (>90% of gambling money spent online) gambling was measured using one question about the proportion of gambling money spent online. Total money gambled and time spent on gambling were also assessed. GD severity (range 0-9) was measured using items reflecting the nine DSM-5 GD criteria. The number of gambling-related problems (e.g., financial difficulties, range 0-10), other addictive disorders and mental health problems were also inquired about. Methods: We estimated a generalised linear model using a count model (negative binomial link function) for GD severity and gambling-related problems associated with the amounts and proportions of money gambled online and offline. Results: The number of GD criteria were associated with money gambled online (IRR [95%CI] = 2.81 [2.43, 3.24]) and offline (IRR = 2.68 [2.40, 3.00]). This was also found for the number of gambling-related problems (IRR = 2.43 [2.13, 2.79] and IRR = 2.89 [2.59, 3.23]). Compared with exclusively-offline gamblers, mixed gamblers (26-90% of money gambled online) showed the highest levels of GD symptoms and gambling-related problems, followed by the almost-exclusively-online gamblers (≥91% money gambled online) and, overall, these associations were still significant after adjustment for overall involvement in gambling (time spent and money gambled). Levels of other addictive disorders and mental health problems were higher among mixed gamblers than among offline-only gamblers, but levels among almost-exclusively-online gamblers were not. Conclusions: Symptoms of gambling disorder and gambling related problems are highest among gamblers engaging in both offline and online gambling. Prevention efforts need to target the combination of offline and online gambling.

Are Changes in Personality Traits and Alcohol Use Associated? A Cohort Study Among Young Swiss Men

Objective: It is well known that certain personality traits are associated with alcohol use. Because less is known about it, we wished to investigate whether changes in alcohol use were longitudinally associated with changes in personality and in which direction the influence or causation might flow. Methods: Data came from the self-reported questionnaire answers of 5,125 young men at two time points during the Cohort study on Substance Use Risk Factors (C-SURF). Their average ages were 20.0 and 25.4 years old at the first and second wave assessments, respectively. Four personality traits were measured: (a) aggression-hostility; (b) sociability; (c) neuroticism-anxiety; and (d) sensation seeking. Alcohol use was measured by volume (drinks per week) and binge drinking (about 60+ grams per occasion). Cross-lagged panel models and two-wave latent change score models were used. Results: Aggression-hostility, sensation seeking, and sociability were significantly and positively cross-sectionally associated with both alcohol use variables. Drinking volume and these three personality traits bidirectionally predicted each other. Binge drinking was bidirectionally associated with sensation-seeking only, whereas aggression-hostility and sociability only predicted binge drinking, but not vice versa. Changes in alcohol use were significantly positively associated with changes in aggression-hostility, sensation seeking, and sociability. Associations reached small Cohen's effect sizes for sociability and sensation seeking, but not for aggression-hostility. Associations with neuroticism-anxiety were mostly not significant. Conclusion: The direction of effects confirmed findings from other studies, and the association between changes in personality and alcohol use support the idea that prevention programs should simultaneously target both.

Identifying an accurate self-reported screening tool for alcohol use disorder: evidence from a Swiss, male population-based assessment

BACKGROUND AND AIMS

Short screenings for alcohol use disorder (AUD) are crucial for public health purposes, but current self-reported measures have several pitfalls and may be unreliable. The main aim of our study was to provide empirical evidence on the psychometric performance of self-reports currently used. Our research questions were: compared with a gold standard clinical interview, how accurate are (1) self-reported AUD, (2) self-reported alcohol use over time and (3) biomarkers of alcohol use among Swiss men? Finally, we aimed to identify an alternative screening tool.

DESIGN

A single-center study with a cross-sectional design and a stratified sample selection.

SETTING

Lausanne University Hospital (Switzerland) from October 2017 to June 2018.

PARTICIPANTS

We selected participants from the French-speaking participants of the ongoing Cohort Study on Substance Use and Risk Factors (n = 233). The sample included young men aged on average 27.0 years.

MEASUREMENTS

We used the Diagnostic Interview for Genetic Studies as the gold standard for DSM-5 AUD. The self-reported measures included 11 criteria for AUD, nine alcohol-related consequences, and previous 12 months' alcohol use. We also assessed biomarkers of chronic excessive drinking (ethyl glucuronide and phosphatidylethanol).

FINDINGS

None of the self-reported measures/biomarkers taken alone displayed both sensitivity and specificity close to 100% with respect to the gold standard (e.g. self-reported AUD: sensitivity = 92.3%, specificity = 45.8%). The best model combined eight self-reported criteria of AUD and four alcohol-related consequences. Using a cut-off of three, this screening tool yielded acceptable sensitivity (83.3%) and specificity (78.7%).

CONCLUSIONS

Neither self-reported alcohol use disorder nor heavy alcohol use appear to be adequate to screen for alcohol use disorder among young men from the Swiss population. The best screening alternative for alcohol use disorder among young Swiss men appears to be a combination of eight symptoms of alcohol use disorder and four alcohol-related consequences.

Multiple trajectories of alcohol use and the development of alcohol use disorder: Do Swiss men mature-out of problematic alcohol use during emerging adulthood?

(A) OBJECTIVE

This study aimed to identify trajectories of alcohol use (AU) and their associations with the development of alcohol use disorder (AUD) among young men with different weekly drinking patterns.

(B) METHOD

A longitudinal latent class analysis integrating several aspects of AU, such as drinking quantity and frequency on weekends vs workweek days, involving 4719 young Swiss men at ages 20, 21, and 25, and collected by the Cohort Study on Substance Use Risk Factors, was used to identify different AU trajectories over time. The development of AUD scores in these trajectories was investigated using generalized linear mixed models.

(C) RESULTS

Six AU trajectory classes, similar to those described in the literature, were identified: 'abstainers-light drinkers', 'light workweek increasers', 'light decreasers', 'moderate weekend decreasers', 'moderate workweek increasers', and 'heavy drinkers'. Only 12% of participants were assigned to a trajectory class with decreasing AU associated with a decline in their AUD score. AUD scores increased in trajectory classes exhibiting increasing AU on workweek days, despite low and moderate general AU. Finally, more than 59% of participants were on an AU trajectory presenting no change in their mean AUD score over time.

(D) CONCLUSIONS

Maturing out of problematic AU in emerging adulthood is not the norm in Switzerland, and the AUD score developed in late adolescence remains until at least emerging adulthood. AU on workweek days is a more practical marker of potentially problematic AU. This calls for timely interventions in adolescence and concerning regular drinking on workweek days in emerging adulthood.

Unique versus shared associations between self-reported behavioral addictions and substance use disorders and mental health problems: A commonality analysis in a large sample of young Swiss men

BACKGROUND AND AIMS

Behavioral addictions (BAs) and substance use disorders (SUDs) tend to co-occur; both are associated with mental health problems (MHPs). This study aimed to estimate the proportion of variance in the severity of MHPs explained by BAs and SUDs, individually and shared between addictions.

METHODS

A sample of 5,516 young Swiss men (mean = 25.47 years old; SD = 1.26) completed a self-reporting questionnaire assessing alcohol, cannabis, and tobacco use disorders, illicit drug use other than cannabis, six BAs (Internet, gaming, smartphone, Internet sex, gambling, and work) and four MHPs (major depression, attention-deficit hyperactivity disorder, social anxiety disorder, and borderline personality disorder). Commonality analysis was used to decompose the variance in the severity of MHPs explained (R²) by BAs and SUDs into independent commonality coefficients. These were calculated for unique BA and SUD contributions and for all types of shared contributions.

RESULTS

BAs and SUDs explained between a fifth and a quarter of the variance in severity of MHPs, but individual addictions explained only about half of this explained variance uniquely; the other half was shared between addictions. A greater proportion of variance was explained uniquely or shared within BAs compared to SUDs, especially for social anxiety disorder.

CONCLUSIONS

The interactions of a broad range of addictions should be considered when investigating their associations with MHPs. BAs explain a larger part of the variance in MHPs than do SUDs and therefore play an important role in their interaction with MHPs.

Cybersex use and problematic cybersex use among young Swiss men: Associations with sociodemographic, sexual, and psychological factors

BACKGROUND AND AIMS

Cybersex use (CU) is highly prevalent in Switzerland's population, particularly among young men. CU may have negative consequences if it gets out of control. This study estimated prevalence of CU, frequency of CU (FCU), and problematic CU (PCU) and their correlates.

METHODS

A non-selective sample of young Swiss men (N = 5,332, mean age = 25.45) completed a questionnaire assessing FCU and PCU, sociodemographics (age, linguistic region, and education), sexuality (being in a relationship, number of sexual partners, and sexual orientation), dysfunctional coping (denial, self-distraction, behavioral disengagement, and self-blame), and personality traits (aggression/hostility, sociability, anxiety/neuroticism, and sensation seeking). Associations were tested using hurdle and negative binomial regression models.

RESULTS

At least monthly CU was reported by 78.6% of participants. CU was associated positively with post-secondary schooling (vs. primary schooling), German-speaking (vs. French-speaking), homosexuality, bisexuality (vs. heterosexuality), more than one sexual partner (vs. one), dysfunctional coping (except denial), and all personality traits except sociability, but negatively with being in a relationship (vs. not), age, and sociability. FCU was associated positively with homosexuality, bisexuality, no or more than one sexual partner, dysfunctional coping (except denial), and all personality traits except sociability, but negatively with age, being in a relationship, and sociability. PCU was associated positively with bisexuality, four or more sexual partners, dysfunctional coping, and all personality traits except sociability, but negatively with German-speaking and sociability.

DISCUSSION AND CONCLUSIONS

CU should be viewed in light of its associations with sociodemographic, sexual, and psychological factors. Healthcare professionals should consider these aspects to adapt their interventions to patients' needs.

Reconsidering the associations between self-reported alcohol use disorder and mental health problems in the light of co-occurring addictions in young Swiss men

BACKGROUND

Alcohol use disorder (AUD) is known to co-occur with other addictions, as well as with mental health problems. However, the effects of other addictions co-occurring with AUD on mental health problems were rarely studied and not considering them may bias estimates of the association between AUD and mental health problems. This study investigated which role co-occurring addictions play for the cross-sectional associations between self-reported AUD and mental health problems.

METHOD

Participants were 5516 young Swiss men (73.0% of those that gave written informed consent) who completed a self-report questionnaire. Using short screening questionnaires, we assessed three substance use disorders (alcohol, cannabis and tobacco), seven behavioural addictions (internet, gaming, smartphone, internet sex, gambling, work, exercise) and four mental health problems (major depression, bipolar disorder, attention deficit hyperactivity disorder (ADHD) and social anxiety disorder). Differences in the proportions of mental health problems were tested using logistic regressions between (1) participants with no AUD and AUD, (2) participants with no AUD and AUD alone and (3) participants with no AUD and AUD plus at least one co-occurring addiction.

RESULTS

Overall, (1) participants with AUD had higher proportions of major depression (Odds ratio (OR [95% confidence interval]) = 3.51 [2.73, 4.52]; ADHD (OR = 3.12 [2.41, 4.03]); bipolar disorder (OR = 4.94 [3.38, 7.21]) and social anxiety (OR = 2.21 [1.79, 2.73])) compared to participants with no AUD. Considering only participants with AUD alone compared to participants with no AUD (2), differences in proportions were no longer significant for major depression (OR = 0.83 [0.42, 1.64]), bipolar disorder (OR = 1.69 [0.67, 4.22]), social anxiety (OR = 1.15 [0.77, 1.73]) and ADHD (OR = 1.65 [1.00, 2.72]) compared to participants with no AUD. In contrast, (3) proportions of mental health problems were considerably higher for participants with AUD plus at least one other addiction when compared to participants with no AUD, with OR's ranging from 2.90 [2.27, 3.70] for social anxiety, 4.03 [3.02, 5.38] for ADHD, 5.29 [4.02, 6.97] for major depression to 6.64 [4.44, 9.94] for bipolar disorder.

CONCLUSIONS

AUD was associated with all four measured mental health problems. However, these associations were mainly due to the high proportions of these mental health problems in participants with AUD plus at least one co-occurring addiction and only to a lesser degree due to participants with AUD alone (i.e. without any other co-occurring addictions). Hence, estimates of the association between AUD and mental health problems that do not consider other addictions may be biased (i.e. overestimated). These findings imply that considering addictions co-occurring with AUD, including behavioural addictions, is important when investigating associations between AUD and mental health problems, and for the treatment of AUD and co-morbid disorders.

Alcohol-induced blackouts at age 20 predict the incidence, maintenance and severity of alcohol dependence at age 25: a prospective study in a sample of young Swiss men

BACKGROUND AND AIMS

Alcohol-induced blackout (AIB) is a common alcohol-related adverse event occurring during teenage years. Although research provides evidence that AIB predicts acute negative consequences, less is known about the associations of AIB with chronic consequences, such as alcohol dependence (AD). This study estimated the associations between an experience of AIB at age 20 and the incidence, maintenance and severity of AD at age 25 among Swiss men.

DESIGN

Prospective cohort study with 5.5 years separating baseline and follow-up.

SETTING

Switzerland.

PARTICIPANTS

Swiss male drinkers (n = 5469, age 20 at baseline) drawn from the Cohort Study on Substance Use Risk Factors (C-SURF).

MEASUREMENTS

Self-report questionnaires assessing AIB, AD, alcohol (drinking volume, binge drinking), cigarette and cannabis use, several risk factors (sensation-seeking, family history of problematic alcohol use, age of first alcohol intoxication) and socio-demographic variables.

FINDINGS

Generalized estimating equation models with and without adjustment for risk factors, including alcohol use and socio-demographics, showed that AIB at age 20 significantly predicted the incidence of AD at age 25 in men without AD at age 20 [odds ratio (OR) = 2.52, 95% confidence interval (CI), unadjusted = 2.04, 3.11, P < 0.001; fully adjusted, OR = 1.47, 95% CI = 1.13, 1.91, P = 0.004], maintenance of AD in men with AD at age 20 (unadjusted, OR = 1.82, 95% CI = 1.12, 2.95, P = 0.015; fully adjusted, OR = 1.66, 95% CI = 1.00, 2.76, P = 0.048] and AD severity [unadjusted incidence rate ratio (IRR) = 1.89, 95% CI = 1.69, 2.11, P < 0.001; fully adjusted, IRR = 1.20, 95% CI = 1.10, 1.31, P < 0.001].

CONCLUSIONS

Among Swiss men, alcohol-induced blackout at age 20 predicts the development, maintenance and severity of alcohol dependence at age 25.

Protective Behavioral Strategies Scale-20: Psychometric properties of a French and German version among young males in Switzerland

OBJECTIVE

The Protective Behavioral Strategies Scale (PBSS-20) is one of the most commonly used measures of engagement in protective behavioral strategies (PBS). This research aimed to examine the psychometric properties of a French and German version of the PBSS-20 in a large sample of young males in Switzerland.

METHOD

The sample included 5,017 young males (mean age = 25.44) participating in the Cohort Study on Substance Use Risk Factors in Switzerland. Measures of PBS use, total drinks per week, and alcohol-related consequences were used from a second follow-up assessment.

RESULTS

Confirmatory factor analysis testing different models previously documented in the literature provided initial support for a four-factor model. Fit statistics indicated that this model adequately reflects the structure of data. Further findings also provided support for adequate internal consistency and for convergent validity of this four-factor model, whereas metric-but not scalar-measurement invariance across linguistic regions was demonstrated.

CONCLUSION

Although further research testing measurement invariance across linguistic regions and gender is warranted, results of the current study suggest that the French and German PBSS-20 is reliable and that it may represent a promising research and clinical tool that can be used in both French- and German-speaking countries.

Development of a short form of the compulsive internet use scale in Switzerland

OBJECTIVES

The study aims to develop a short form of the compulsive internet use scale (CIUS), which can be used in multitopic and general population health surveys and is invariant across different sexes, linguistic regions, and ages.

METHODS

Two general population surveys from 2013 and 2015 were used as learning (n = 1,371) and validation samples (n = 1,550), respectively. Reducing items from the original CIUS was based on the following: (a) correlated errors between items, (b) differential item functioning, and (c) measurement invariance. Methods used item response theory and latent confirmatory factor analysis for ordinal variables.

RESULTS

The eight-item short form maintained the five dimensions of the original scale and was metric and mostly scale invariant for sex, region, and age. It fell marginally short of scale invariance (ΔCFI < 0.01) for regions in the learning sample and for sexes in the validation sample (both ΔCFI = 0.013, p < 0.01). Root mean square error of approximation was 0.045 and 0.036, and comparative fit index was 0.989 and 0.995, in the learning and validation samples, respectively, showing excellent fit of the model to data. Correlations with the full scale were r = 0.966 (learning) and r = 0.969 (validation).

CONCLUSION

If the full 14-item CIUS is a valid, reliable screening instrument, then the short eight-item form is too, and can be used in multitopic, general population health surveys.

Non-medical use of prescription drugs by young men: impact of potentially traumatic events and of social-environmental stressors

Background: Non-medical use of prescription drugs (NMUPD) is an increasing phenomenon associated with physical and psychological consequences. This study investigated the effects of distinct forms of stress on NMUPD. Methods: Data from 5308 young adult men from the Swiss cohort study on substance use risk factors (C-SURF) were analysed regarding NMUPD of sleeping pills, tranquilizers, opioid analgesics, psychostimulants, and antidepressants. Various forms of stress (discrete, potentially traumatic events, recent and long-lasting social-environmental stressors) during the period preceding the NMUPD assessment were measured. Backward log-binomial regression was performed and risk ratios (RR) were calculated. Results: NMUPD was significantly associated with the cumulative number of potentially traumatic events (e.g. for opioid analgesics, RR = 1.92, p < .001), with problems within the family (e.g. for sleeping pills, RR = 2.45, p < .001), and the peer group (e.g. for tranquilizer use, RR = 2.34, p < .01). Factors describing family functioning in childhood showed very few significant associations. Sexual assault by acquaintances was associated only with use of sleeping pills (RR = 2.91, p p <.01); physical assault by acquaintances was not associated with NMUPD. Physical (e.g. for psychostimulants, RR = 2.01, p < .001) or sexual assaults (e.g. for antidepressants, RR = 4.64, p < .001) perpetrated outside the family context did show associations with several drug categories. Conclusion: NMUPD appears to be more consistently associated with discrete and potentially traumatic events and with recent social-environmental stressors than with long-lasting stressors due to family functioning during childhood and youth. Physical and sexual assaults perpetrated by strangers showed more associations with NMUPD than those perpetrated by a family member.

Bidirectional Associations Between Self-Reported Gaming Disorder and Adult Attention Deficit Hyperactivity Disorder: Evidence From a Sample of Young Swiss Men

Background: Gaming disorder (GD) has been shown to co-occur with attention deficit hyperactivity disorder (ADHD), yet few studies to date have investigated their longitudinal associations. Method: The sample included 5,067 young Swiss men (mean age was 20 years at wave 1 and 25 years at wave 3). Measures were the Game Addiction Scale and the Adult ADHD Self-Report Scale (6-item screener). Longitudinal associations were tested using autoregressive cross-lagged models for binary measures of GD and ADHD, as well as continuous measures for GD score and ADHD subscales of inattention and hyperactivity. Results: ADHD at age 20 increased the risk for GD at age 25 (probit = 0.066 [0.023, 0.109]; p = 0.003). GD at age 20 also increased the risk for ADHD at wave 3 (probit = 0.058 [0.013, 0.102]; p = 0.011). Only the ADHD inattention subscale showed a bidirectional longitudinal relationship with the GD score (standardized Beta from inattention at age 20 to GD score at age 25: 0.090 [0.056, 0.124]; p < 0.001; from GD score at age 20 to inattention at age 25: 0.044 [0.016, 0.071]; p = 0.002), whereas associations between the hyperactivity subscale and GD were not significant. Discussion: GD had bidirectional longitudinal associations with ADHD, in that ADHD increased the risk for GD and GD increased the risk for ADHD, and they may reinforce each other. These associations may be linked more to the inattention ADHD component than to the hyperactivity ADHD component. Individuals with ADHD or GD should be screened for the other disorder, and preventive measures for GD should be evaluated in individuals with ADHD.

The importance of age groups in estimates of alcohol-attributable mortality: impact on trends in Switzerland between 1997 and 2011

BACKGROUND AND AIMS

Monitoring trends of alcohol-attributable mortality is an integral part of the global strategy to reduce the harmful use of alcohol. However, mortality estimates based on different age ranges come to different conclusions. This study examined the impact of including different age ranges in terms of directions of trends of alcohol-attributable mortality during 14 years in Switzerland.

METHOD

Alcohol-attributable mortality was estimated at four time-points between 1997 and 2011 using the Global Burden of Disease 2010 methodology. Estimates were obtained for two age groups: 15-64 years and the total adult population (15 years and older).

RESULTS

Alcohol-attributable mortality among 15-64-year-olds decreased [1997: 1334 deaths, confidence interval (CI) = 1237-1432; 2011: 1019 deaths, CI = 964-1073; trend per year odds ratio (OR) = 0.99, P < 0.001]. In contrast, alcohol-attributable mortality among those 65 and older increased in the same time-period (1997: 581 deaths, CI = -196 to 1357; 2011: 1664 deaths, CI = 957-2372; OR = 1.07, P< 0.001), resulting in an overall increase of alcohol-attributable mortality for 15+ year-olds (1997: 1915 deaths, CI = 1133-2697; 2011: 2683, CI = 1973-3393; OR = 1.02, P < 0.001). The main shift in trends was due to changes in the mixture (e.g. hypertension, ischaemic heart disease) of cardiovascular diseases over time among those 65+ years old.

CONCLUSIONS

Trends in alcohol-attributable mortality may yield qualitatively different results based on the upper age limit for deaths set for these estimates. Global trends of alcohol-attributable mortality between 1997 and 2011 were influenced heavily by changes in the mixture of deaths across cardiovascular diseases. Trends for alcohol-attributable mortality and cross-country comparisons should be reported separately for 15-64 and 65+ year-olds.

Prevalence of and potential influencing factors for alcohol dependence in Europe

Alcohol use disorders (AUDs), and alcohol dependence (AD) in particular, are prevalent and associated with a large burden of disability and mortality. The aim of this study was to estimate prevalence of AD in the European Union (EU), Iceland, Norway, and Switzerland for the year 2010, and to investigate potential influencing factors. The 1-year prevalence of AD in the EU was estimated at 3.4% among people 18-64 years of age in Europe (women 1.7%, men 5.2%), resulting in close to 11 million affected people. Taking into account all people of all ages, AD, abuse and harmful use resulted in an estimate of 23 million affected people. Prevalence of AD varied widely between European countries, and was significantly impacted by drinking cultures and social norms. Correlations with level of drinking and other drinking variables and with major known outcomes of heavy drinking, such as liver cirrhosis or injury, were moderate. These results suggest a need to rethink the definition of AUDs.

Alcohol-attributable mortality in Switzerland in 2011--age-specific causes of death and impact of heavy versus non-heavy drinking

BACKGROUND

Alcohol use causes high burden of disease and injury globally. Switzerland has a high consumption of alcohol, almost twice the global average. Alcohol-attributable deaths and years of life lost in Switzerland were estimated by age and sex for the year 2011. Additionally, the impact of heavy drinking (40+grams/day for women and 60+g/day for men) was estimated.

METHODS

Alcohol consumption estimates were based on the Addiction Monitoring in Switzerland study and were adjusted to per capita consumption based on sales data. Mortality data were taken from the Swiss mortality register. Methodology of the Comparative Risk Assessment for alcohol was used to estimate alcohol-attributable fractions.

RESULTS

Alcohol use caused 1,600 (95% CI: 1,472 - 1,728) net deaths (1,768 deaths caused, 168 deaths prevented) among 15 to 74 year olds, corresponding to 8.7% of all deaths (men: 1,181 deaths; women: 419 deaths). Overall, 42,627 years of life (9.7%, 95% CI: 40,245 - 45,008) were lost due to alcohol. Main causes of alcohol-attributable mortality were injuries at younger ages (15-34 years), with increasing age digestive diseases (mainly liver cirrhosis) and cancers (particularly breast cancers among women). The majority (62%) of all alcohol-attributable deaths was caused by chronic heavy drinking (men: 67%; women: 48 %).

CONCLUSION

Alcohol is a major cause of premature mortality in Switzerland. Its impact, among young people mainly via injuries, among men mainly through heavy drinking, calls for a mix of preventive actions targeting chronic heavy drinking, binge drinking and mean consumption.